II. Epidemiology
-
Prevalence
- Meconium-stained amniotic fluid is present in up to 15% of deliveries
- Meconium Aspiration Syndrome occurs in only 1% of all deliveries
III. Pathophysiology
- Meconium contains gastrointestinal fluids which cause localized inflammation
- Meconium Aspiration results in severe airway inflammation and Pneumonia risk
- Meconium Aspiration occurs in utero, not at delivery
IV. Signs
V. Differential Diagnosis
VI. Imaging: Chest XRay
- Patchy Atelectasis (fluffy densities)
- Hyperinflation
- Lung consolidation changes
VII. Management: Meconium stained infant
- See Respiratory Distress in the Newborn
- See Newborn Resuscitation
- Infant brought to warmer with head angled down and with minimal stimulation
- Oxygenation and ventilation
- Supplemental Oxygen 21-50% FIO2 to keep Oxygen Saturation >90%
- Non-Invasive Positive Pressure Ventilation (e.g. N-CPAP)
- Endotracheal Intubation may be required
- Evaluate infant for vigorous activity
- Vigorous infants without distress may be managed routinely
- Infants with Heart Rate <100 beats/min, apnea, or poor tone require intervention
- Intubation
- Suctioning
VIII. Prevention
- Suctioning head at the perineum no longer recommended
- See pathophysiology above regarding in utero aspiration
- Vain (2004) Lancet 364:597-602 [PubMed]
- Amnioinfusion does not decrease Meconium Aspiration risk